Diagnostic interviews are widely used by mental health professionals to identify conditions such as anxiety, bipolar disorder and depression in adults, but new research led by McMaster University shows that the long-held “gold standard” may not be as consistent as previously thought.
Meta-analysis published in JAMA network open May 28 found that standardized diagnostic interviews are only moderately consistent when the same person is evaluated multiple times. In some cases, repeated interviews just a few days apart identified individuals with different diagnoses. Furthermore, this consistency varies widely depending on which disease is being evaluated.
The study’s conclusions are particularly concerning because inconsistent diagnosis can lead to over- or under-treatment, delayed treatment, or inappropriate interventions, highlighting the need for improved diagnostic tools and the need for greater caution when relying on a single interview to define mental illness.
Our findings show that these interviews are not as reliable or consistent as many believe. We’d like to think that if we conducted the same interview with the same person twice, the interviews would yield the same results, but that’s not always the case. ”
Laura Duncan, senior author, assistant professor in the McMaster Department of Psychiatry and Behavioral Neuroscience, and researcher at Offord Children’s Research Center
This study found that diagnostic interviews were more consistent for substance use disorders than for many mental disorders. Researchers say this may be because conditions such as anxiety, depression, and psychotic disorders are more subjective experiences, requiring the use of standardized interviews with recognition of their limitations. .
“These differences suggest that structured interviews are more effective for diseases with clear behaviors and timelines than for diseases that rely more on individual experience and interpretation,” Duncan says. “However, treating them as the ‘gold standard’ of evaluation should be reconsidered. Reliable diagnosis will likely require a combination of standardized tools and knowledge of the course and complexity of the disease, which may influence how reliable an assessment can be made. ”
Standardized diagnostic interviews are structured assessment tools commonly used to diagnose mental health disorders. As part of the interview, you will be asked about any changes in your mood or behavior, as well as the frequency and severity of your symptoms and, in some cases, how much they affect your daily life.
To conduct the study, researchers meta-analyzed 57 studies involving more than 8,000 adults from 26 countries. This study focused on test-retest reliability. This is a measure of whether an interview yields the same results when repeated with the same person under similar conditions, usually after 7 to 14 days.
This research was supported by collaborators at Copenhagen University Hospital, Massachusetts Chan College of Medicine, and St. Joseph’s Healthcare Hamilton.
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Reference magazines:
Xie, W. et al. (2026) Test-retest reliability of standardized diagnostic interviews for common adult mental disorders: A systematic review and meta-analysis. JAMA network open. DOI: 10.1001/jamanetworkopen.2026.15039. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2849585
